PRAIRIE VILLAGE, KS — Back when Al Cross was a newspaper reporter, he now admits, “I avoided healthcare stories like the plague. I just didn’t want to take the time to learn about it.”

Now, as the director of the University of Kentucky’s Institute for Rural Journalism and Community Issues, the former Louisville Courier-Journal scribe spends much of his time trying to convince small-town editors and reporters not to make the same mistake he did.

But, he says, “It’s a Sisyphean struggle.”

As implementation of the Affordable Care Act moves along, the law has far-reaching and sometimes unique implications for rural communities—yet few rural newsrooms seem ready or able to cover the story in all its complexity.

Cross and one of his students, Justin Richter, recently conducted a content analysis of ACA coverage in Appalachian Kentucky, “one of the unhealthiest and poorest regions of the country.” They found that newspapers there “gave their readers limited information” about the law in the two months leading up to the launch of the online insurance exchanges on Oct. 1, and coverage “was dominated by opinions of public officials, largely those opposed to the law.”

“Opinion almost outran news,” Cross says, “and almost one-fourth of the coverage consisted of the opinions of Mitch McConnell”—the Republican Senate minority leader who is running for reelection in Kentucky—either in the form of guest columns or stories recording his views on the health law.

Here in the Midwest, a corresponding review of ACA coverage in smaller communities would reveal similar patterns—a surplus of opinion, often in the form of guest editorials and video news releases from politicians, and a dearth of unbiased, explanatory reporting on the law and its effects.

And those effects are multifaceted. Rural Americans are more likely to be underinsured and low-income—and in a position to benefit from ACA subsidies. But rural areas also tend to have fewer options when it comes to doctors, hospitals, and insurers—scarcities that the ACA mandates and other reforms could exacerbate. Kansas, Nebraska, and Missouri, like many other “red” states in the Midwest and South with large rural populations, so far have refused to accept the ACA’s Medicaid expansion, leaving many low-income residents still unable to get affordable insurance. And these health coverage gaps are mirrored by media-coverage gaps, which the local politicians who drive much media coverage aren’t eager to help fill.

“I would say that health policy issues in general, particularly the ACA … have been very unevenly covered in Kansas,” says Mike Shields, managing editor of the nonprofit Kansas Health Institute news service, one of the few outlets in the region to have done sustained, in-depth Obamacare coverage.

Where to look, and what to ask

In fairness, every small-town or even regional newsroom has limited resources, and a set of editorial priorities that doesn’t typically include national political issues.

“Virtually every community newspaper in this country is interested in covering only their community, and they leave larger issues to the larger papers,” Cross says. “Their coverage tends to stop at the county line or the township line.”

But as California-based columnist Joe Mathews argued last month, while the Obamacare fight was national, implementation of the Affordable Care Act is in many ways a local story. According to Mathews, “the wisest thing most of us can do is focus on our own home regions—the prices our neighbors are paying for insurance and healthcare, the health of people in the neighborhood and the mix of hospitals, doctors’ groups, clinics and insurance plans near us.”

In other words, local sources are valuable. That’s what Cristina Janney of Kansas’ McPherson Sentinel discovered when reporting her December piece about Obamacare’s effects on hospitals—one of the few ambitious ACA stories to emerge from small-town reporters in the region.

“I started with my local sources, went to my local hospital administrators, and then I branched out from there,” Janney says.

Deron Lee is CJR's correspondent for Iowa, Missouri, Kansas, and Nebraska. A writer and copy editor who has spent seven years with the National Journal Group, he has also contributed to The Hotline and the Lawrence Journal-World. He lives in the Kansas City area. Follow him on Twitter at @deron_lee.